STERILIZATION METHODS CTVT PAGES 1158 1168 Objectives Understand

STERILIZATION METHODS CTVT PAGES 1158 -1168 Objectives: Understand aseptic technique and it’s importance in surgery. Learn how to properly sterilize instruments and equipment.

Asepsis- condition of sterility where no living organisms are present Aseptic technique- all steps taken to prevent contamination of surgical site by infectious agents Goal: to maintain asepsis and watch for “breaks” in aseptic technique

Ways to Maintain Aseptic Technique Disinfection - destruction of pathogens on inanimate objects (Kennel Care, Accel) o Doesn’t effect bacteria spores Sanitization - acceptable level of contaminants present Antiseptic – inhibits growth of infectious agents on living tissue (Chlorhexidine) Sterilization - complete destruction or elimination of all living organisms Including viruses and bacterial spores o Always inorganic material o

When does aseptic technique begin? It’s always happening! o Cleaning of instruments (see Instrument Guide) o Surgery suite sanitation/disinfection o Patient prep o Surgical team scrub o Surgical suite etiquette Contamination cannot always be avoided o Skin abscess, wounds, organ rupture, dental disease

Methods of Sterilization 1. Physical Sterilization Filtration Radiation Heat 2. Chemical Sterilization Liquid Gas

1. Filtration Sterilization Microorganisms separated from liquid o Utilized by pharmaceutical companies o Filter can be placed on IV line or syringe P

P 2. Radiation Sterilization Destruction of microorganism without significant increase in temperature o Ex. Gloves and suture material *Filtration and radiation are typically performed by the manufacturer before shipments - anything that comes pre-sterilized - a lot of “one time use” products - items which cannot be heat sterilized

3. Heat Sterilization Most common sterilization technique Destroys bacteria by denaturing their proteins Two options: a. Dry Heat Sterilization o High temperatures for a long period of time b. Wet Heat Sterilization o Creating steam under pressure at high temperatures P

a. Dry Heat Sterilization Used for instruments sensitive to moisture Advantage: no rust or corrosion Disadvantages: o Takes longer than wet heat o Requires ________ temperatures o Not for items that can burn Ex. setting= 300°f for 2 ½ hours P

b. Wet Heat Sterilization Pack must be able to withstand heat AND moisture! 1. Pre-vacuum sterilizer A pump evacuates the air before the steam enters More even penetration of steam o Shorter duration o 2. Gravity Displacement Sterilizer Steam enters the top and forces air to bottom Most commonly used type P

Autoclave Sterilization (Gravity Displacement) Used most commonly for “packs” Heat = _______ °F minimum Pressure = ______ PSI Time = _____ minutes at temp (exposure time) o Total cycle =Heat-up + exposure + dry time o Usually 45 -60 minute cycle total Always use _______ water! *Every machine is different, refer to the operator's manual

Proper placement of packs in the autoclave: Steam should be allowed to flow around every surface of each pack Use multiple racks if sterilizing a lot of packs

Pack Preparation 1. Instruments must be clean and dry 2. All locking instruments should be _________ 3. Should be labeled appropriately 4. Sharp edges should be protected 5. Should contain a _______________

Pack Materials Wrap materials must be steam permeable 1. Woven = double thickness _______ o Reusable 2. Non-woven = crepe paper o One time use …mostly 3. Laminate packs/peel pouches o clear pouches made of plastic and paper **According to AAHA practices, all packs should be double wrapped

Pouch Preparation Instrument is placed into pouch with the handles toward the ______ end Pre-cut sizes or on rolls Self-sealing or heat sealed Plastic side should face down in autoclave

Labeling of Packs Three requirements: 1. ____________ 2. ____________ 3. ____________ *VTI- which patient it is for

Sterility Indicators 1. Autoclave Tape –specific part of the pack was exposed to steam o Commonly used on the outside of packs o Use sharpie to write information directly on tape o Tape should NOT be used to keep the pack closed

Sterility Indicators 2. Chemical Indicator Strips- change color when exposed to steam for adequate time Examples: o Peel packs – indicator on the outside of the paper o OK Strip - can be placed in the center of the pack o Chemical sticker- can be placed anywhere (mostly for gas)

Sterility Indicators 3. Pellet glass – glass ampule containing a temperature sensitive pellet that melts 250 °F around 4. Biological/Culture tests – contain a spore population of bacteria (usually Bacillus sp. ) o Confirms that microorganisms were in fact killed if the sample does not grow anything after incubation o Disadvantage: o Most effective method for testing machine functionality- not individual packs

Autoclave Quality Control Performed by the technicians to ensure proper sterilization technique is being used 1. Sterility Indicators o Must be used in combination, as not just one will cover all requirements 2. Autoclave maintenance o Ex. Speed-Clean – liquid is mixed into water o Ex. Chamber Brite – powder is sprinkled on the bottom of cold chamber; cycle is ran without drying *Both require a “rinse” cycle to be ran after use

After the Autoclave Cycle Let the dry cycle finish completely! Packs must cool slowly to prevent condensation which could: 1. 2. 3. Door should be cracked to vent first Open door with caution!

Maintaining Sterile Packs The outside is not sterile Storage: dust free, dry, well-ventilated, away from contaminated areas o Ex. A closed cabinet is safer than an open area Broken sterility = dropped on floor, wet, broken outer wrap (ex. instrument penetrates paper) o Never assume sterility - autoclave again if pack is in question Monitor dates for expired sterility (follow clinic protocol)

Length of Sterility Table on page 1163 in CTVT 1. Date related practice: Which one lasts longer? Double vs. single wrapped Non-woven vs. Woven Closed vs. open cabinet Heat sealed vs. Self-sealed 2. Event related practice: item is sterile until an event in which the sterility is broken

Flash Sterilization Instruments are placed _____________ in a perforated metal tray ____ for _____ minute exposure time Removed with detachable metal handles and carried straight to surgery (or use oven mitt or huck towel) Instruments must cool before use Some machines have a preset button